Author: Andrew Leung, DO, MA
Co Author #1: Kaleigh Suhs, D.O.
Senior Editor: Rahul Kapur, MD
Editor: Amanda Phillips, MD, MPH

Patient Presentation:
A 27-year-old female with no significant past medical history presented with a 5-month history of intermittent right shoulder pain without inciting trauma.

History:
Her pain was isolated to the anterior aspect of her right shoulder and worsened with overhead motions and sleeping on the shoulder. Her pain restricted her range of motion. She previously performed yoga for exercise but stopped 3 months prior. Her only treatment was occasional
non-steroidal anti-inflammatory use. She denied a history of similar symptoms of shoulder pain or other joints. She denied recent signs of infection or family history of rheumatoid arthritis, systemic lupus
erythematosus, or gout. She worked a low-demand sedentary desk job at an advertising agency. Initially she was prescribed a course of scheduled non-steroidal anti-inflammatory medication and referred to physical therapy.
At her 6-week follow-up, she noted initial improvement which regressed. At that time, she noted
increased pain, decreased range of motion, and new-onset shoulder weakness.

Physical Exam:
Right shoulder: No overlying erythema or ecchymosis. She exhibited mild tenderness along her right anterior shoulder around the proximal long head of biceps tendon. No definitive
deformity of biceps muscle with resisted forward flexion and abduction of the right shoulder. Her active range of motion was severely reduced in all planes. Rotator cuff strength 4+/5. Significant weakness
was noted with biceps activation. Positive special tests include Hawkins, Neer, Yergason, Speed's.
Jobe: No active abduction due to pain/weakness. She was alert and oriented to person/place/time.
No acute respiratory distress. Her pupils were equal, round, reactive to light and accommodation,and extraocular muscles were intact. The remainder of her skin is warm and dry with no rashes noted. Her affect and behavior were appropriate.

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